It seems that over the last decade more and more research is being published on the role of the scapula (shoulder blade) in athletic shoulder injuries. Perhaps it is safe to say that in the past, most of the research was focused on the more obvious, common structures that get damaged in the shoulder as opposed to looking at subtle dysfunctions which may predispose someone to injury.
The scapula is the technical term for our shoulder blade. Scapular dyskinesis is a relatively new concept that refers to aberrant movements of the shoulder blade. For example, many baseball players have different movement patterns around their shoulder blades. This is because repeatedly throwing changes the balance of muscle use around the shoulder and scapula, changing the way the entire area functions. As practitioners, we can now use the scapula and the clinical movement of the scapula as a way to decipher the cause of someones shoulder pain.
The “sick scapula” is a slang term used by some practitioners describing various changes in the shoulder (or shoulder blade to be more precise). In this situation, the athlete’s shoulder blade will appear in the wrong position at rest (for example the bottom end of it may protrude too much), the front of the shoulder near your chest muscle might be painful with pressure and the shoulder blade (scapula) might move differently when compared to the other shoulder blade.
These shoulder injuries usually have normal imaging findings. That is, x-rays don’t show any bony injury and soft tissue imaging (like ultrasound or MRI) fail to show any soft tissue damage. In other words, there isn’t anything torn or broken, but rather certain muscles have shortened and changed the way the entire shoulder functions. Other muscles may have become weak as a result.
Treatment for altered shoulder movement and function (attributed to something like throwing) often involves a “re-balancing” of the muscles. Muscles that are too tight need to be stretched. If they are overused, active release or graston might be helpful in removing scar tissue. Strengthening is always an important part of the rehabilitative process to help “undo” some of the changes and prevent them from recurring.
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Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology part III: the sick scapula, scapular dyskinesis, the kinetic chain and rehabilitation. The Journal of Arthroscopic and Related Surgery 2003; 19(6): 641-661.